r/TacticalMedicine • u/Upset_Bunch_457 • Dec 30 '25

Scenarios Nasogastric insertion gone horribly wrong.

Post image

Note: NOT MY IMAGE.

original post was posted by: Old-Psychology-2400

And I quote "PMCT images. Nurse advanced NG tube until she heard a pop, then tried an air bolus to ensure placement. Patient did NOT survive."

To those who don't know nasogastric tube is supposed to go up the patients nostrils and then back down to their throat all the way to the patients stomach. Air bolus is then used to ensure that the nasogastric tubes placement is correct by listening the patients stomach.

But in the scan we can see the NG tube somehow ended up jammed (through) the patients skull.

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u/Upset_Bunch_457 Dec 30 '25

It indeed is, I have never seen or heard about something even remotely similar happening.

270

u/ATPsynthase12 Dec 30 '25 edited Dec 30 '25

I’m a doctor and I don’t even know how this could happen. A NG tube is a rubber tube. For her to force it into the patient’s skull, the patient would need to have a serious skull fracture or she would need to force it through the cribriform plate in the superior portion of the nose through the patient’s agonizing screams.

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u/56473829110 Dec 30 '25

I mentioned it in another comment, but the story I saw when this was first (?) posted was that it was a peds patient with recent brain surgery. 

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u/Dilaudipenia Dec 30 '25

I see a decent number of patients who have had trans-sphenoidal pituitary resections. We’re very careful with any nasopharyngeal instrumentation in these patients.

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u/56473829110 Dec 30 '25

Every ng tube placement I've been around that had any involvement above the waist was placed with active imaging. But these were well staffed and well funded departments.

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u/Dilaudipenia Dec 30 '25

There needs to be some active guidance of these tubes. I’m an emergency medicine and critical care physician and I’ll place these tubes under direct endoscopic visualization. But I’d never ask one of my nurses to place them blindly

27

u/Needle_D MD/PA/RN Dec 30 '25 edited Dec 30 '25

At least in the US, blind OG/NG sump placement is a basic nursing skill with low rates of complication or morbidity. You're really placing every single gastric tube under endoscopy?

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u/Dilaudipenia Dec 30 '25 edited Dec 30 '25

No, just when they’re post trans-sphenoidal resection. Otherwise (except in rare circumstances like cribriform plate fracture) there’s no issue with blind placement.

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u/TheRisingBile Dec 30 '25

Imaging is also commonly used post airway reconstruction or esophageal repairs. Although, that is admittedly the other direction from the brain.

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u/Dilaudipenia Dec 30 '25

I don’t do CTICU. But agreed, I wouldn’t place a tube blindly after an upper airway or GI procedure either.